Cancer

Malignant neoplasms, or cancers, are second only to heart disease as a cause of death in American adults. Cancer may attack the skin, the oral

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Male Female 15-44 years 45-64 years 65+ years

Sex or Age of Patient Group

Figure 3-4 Number of discharges with first-listed diagnosis of malignant neoplasms from short-stay hospitals by first-listed diagnosis, sex, and age: United States,

1994. (Based on data from Graves & Gillum, 1996.)

Male Female 15-44 years 45-64 years 65+ years

Sex or Age of Patient Group

Figure 3-4 Number of discharges with first-listed diagnosis of malignant neoplasms from short-stay hospitals by first-listed diagnosis, sex, and age: United States,

1994. (Based on data from Graves & Gillum, 1996.)

cavity, the digestive organs, the respiratory organs, the breasts, the genital organs, the urinary organs, the blood, and other body sites. Death rates are highest for cancer of the respiratory and digestive organs, but cancer of the breast, which is more treatable, also occurs at a higher frequency. As shown in Figure 3-4, the incidence of these three types of cancer increases during adulthood. In general, the death rates for all types of cancer are greater during later adulthood than during young and middle adulthood. However, cancer also occurs among young adults and children: Leukemia and brain tumors are more common in childhood, whereas cervical, lung, and stomach cancer increase during the middle thirties. Finally, the frequency of cancer of the breast, uterus, colon, stomach, and liver is highest in older adulthood (Krakoff, 1993). Middle-aged and older women, in particular, are at high risk for breast cancer, and older men are at high risk for lung cancer and prostate cancer.

The incidence and death rates of different types of cancer vary with ethnicity and sex. In the United States, for all ages combined, the highest rate of death due to malignant neoplasms and respiratory cancer occurs among black males, followed by white males, black females, and white females. The death rate for breast cancer is also higher among black women than white women (National Center for Health Statistics. 1995). The cancer death rate for men surpasses that for women in all age ranges except ages 25-44, when the rate is slightly higher for both white and black women than for men (Singh et al., 1996). Note that these are the childbearing years for women.

Because cancer often goes undetected until it is well advanced, it is sometimes referred to as the "silent killer." Emphasis should be placed on early detection and diagnosis, however, because treatment is usually more effective in the early stages of the disease. It is recommended that persons having one or more of the following "seven warning signs" of cancer should consult a physician: (1) a sore that doesn't heal; (2) change in a wart or mole; (3) a lump or thickening in the breast or elsewhere on the body; (4) persisting hoarseness or cough; (5) chronic indigestion or difficulty swallowing; (6) unusual bleeding or discharge; (7) change in bowel or bladder habits.

As is the case with heart disease, an ounce of prevention is probably worth a pound of cure when it comes to cancer; early diagnosis is critical to surviving cancer at any age. A number of potential carcinogenic (cancer-producing) agents, ranging from alcohol to sunlight, have been studied. Polluting physical and chemical substances in the environment, nutritional deficiencies, and excessive intake of fats, hormones, and radiation have all been examined as possible contributing causes to cancers of the liver, skin, bladder, lungs, larynx, esophagus, liver, breast, uterus, vagina, and prostate. Many of these agents have marginal, if any, significant effects on the development of cancers and, in any case, may not be under direct control. One of the most preventable lifestyle factors implicated in cancer, however, is cigarette smoking. It has been linked to over 80% of all cases of lung cancer and 30% of all deaths due to cancer (American Cancer Society, 1987).

Standard treatments for cancer include radiation therapy (external administration of X rays, internal administration of radioactive materials), chemotherapy (antimetabolites, antibiotics, metallic salts, hormones), surgery, and supportive treatments. Although a great deal of media attention has been devoted to the role of psychological factors such as depression, coping style, and internal locus of control in the etiology and treament of cancer, related research findings have not been impressive (Jamison, Burish, & Wallston, 1987; Richardson, Zarnegar, Bisno, & Levine, 1990).

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